Snowmobile Registration & Title Application - Vermont Department ...

DEPARTMENT USE ONLY – DO NOT WRITE IN SHADED AREAS
This Application Must Be Accompanied By a Vermont Sales &
Use Tax Return (form SU-452), Proof that the Vermont Sales &
Use Tax Has Been Paid or Proof of Tax Paid in Another State.
1
2
New (421)
Transfer (431)
Renewal (475)
Title Only
Make (If Homemade, So State)
3 OWNER
490 C 490 P
Non-Resident _____
EXPIRES (YY/MM)
/ 08
231 232 233
225 227
Decal # Attached to Snowmobile ______________ Expiration Year of Validation Sticker ________ If None, Check Box
Year Color Odometer Reading Identification Number (VIN) NEW USED
ANTIQUE
VT DRIVER LICENSE NO GENDER
M F CO-OWNER
Name Name
Mailing Address (PO Box or Street):
Mailing Address (PO Box or Street):
VT DRIVER LICENSE NO GENDER
M F
City: State: ZIP: City: State: ZIP:
Physical Address (Street):
Physical Address (Street):
City: State: ZIP: City: State: ZIP:
DATE OF BIRTH: IF NAME HAS CHANGED, LIST PREVIOUS NAME; DATE OF BIRTH: IF NAME HAS CHANGED, LIST PREVIOUS NAME;
Phone Number and/or Email Address:
MUST INDICATE RIGHTS OF SURVIVORSHIP (CHECK ONE) IF NO
BOX IS CHECKED “JOINT TENTANTS” WILL BE SELECTED
4
NAME OF LIENHOLDER DATE OF BIRTH (If individual)
MAILING ADDRESS - STREET, CITY, STATE, ZIP CODE
IF NO LOAN,
CHECK BOX
DATE OF LOAN VT LICENSE NO IS THERE A SECOND
LOAN? IF YES, CHECK
6
7
SPOUSES JOINT TENANTS TENANTS IN COMMON PARTNERS (business)
BOX & SEND DETAILS
I Certify That The VT Sales And Use Tax Has Been Collected From The Purchaser And Paid To The VT Dept. Of
Taxes
5
Address
Address
Signature
Dealer Name:
Signature of Dealer Or Authorized Agent: Date: Vermont Tax No: VT DEALER NUMBER
TO BE COMPLETED BY VAST AGENTS/DEALERS ONLY
(NOTE: RENEWAL BY VAST AGENTS ONLY)
DATE ISSUED: _______________________________
V.A.S.T. AGENT / DEALER # ____________________
_____________________________________________________________
V.A.S.T. AGENT / DEALER SIGNATURE: (circle one)
60 DAY TEMPORARY
REGISTRATION #
____________________
New Decal
Renewal
Seller Name Date Purchased
(New Plate Antique)
Replacement $5.00
9 Purchase Price 9A TO CLAIM TAX CREDIT, COMPLETE SECTION 9A 12
PURCHASE PRICE $
PURCHASER OF OLD SNOWMOBILE
TAX CREDIT $
NET TAXABLE COST $
TAX (6%) $
CITY STATE ON (DATE)
YEAR MAKE Reg # TAX EXEMPT #
VIN
TAX EXEMPTION FOR OUT-OF-STATE DELIVERY TO A NON-VERMONT RESIDENT. MUST INCLUDE INVOICE WITH
DELIVERY LOCATION OUTSIDE OF VERMONT
10 VERIFICATION OF SERIAL NUMBER - APPLICANT SHOULD NOT WRITE IN THIS SECTION
SERIAL NUMBER (VIN) - NO ALTERATIONS OR ERASURES ACCEPTED
DATE AT TOWN OR CITY STATE
8
SELECT ONE:
Resident $25.00
Non-Resident $32.00
Antique $42.00
Transfer $2.00
8
A
Registration 36
Tax
Title
$20.00 +
$10.00 per loan
NON-RESIDENTS
MUST COMPLETE THE
FOLLOWING
HOME STATE_________
I have applied for my
snowmobile title
YES NO N/A
DO NOT SEND CASH
DO NOT WRITE IN SHADED AREA
39
03
Transfer 36
Misc
Total $
AUTHORIZED SIGNATURE ORGANIZATION Return # Rater # RF
NCIC
Y N
VINASSIST
Y N
STATE OF REG PHONE NUMBER
White – DMV, Yellow - VAST/Dealer, Pink - Customer
11
I Certify That I Am The Owner Of The Snowmobile Described Above And Same Is Properly Equipped And In Good Mechanical Condition. Statements and warrants
herein are certified under penalty of 23 V.S.A. §202, §203 & §3829
SIGNATURE (OWNER) DATE SIGNATURE (CO-OWNER)